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2019 Statewide Needs Assessment

Data collection for the 2019 Needs Assessment included administrative data from health, education, and child welfare that was integrated across the population of birth-to-five using our IDS; family and provider surveys to gather statewide perspectives on access and barriers to care; family and provider focus groups to understand voices of our community and the systemic strengths and disconnects that need addressed; and statewide community listening sessions that identified the top five critical issues facing Iowa communities’ ability to thrive.

Early Childhood Iowa Statewide Needs Assessment 2019

This publication was made possible by the Preschool Development Grant Birth to Five (Grant Number 90TP0030-01-00) from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services as part of a grant totaling $2,190,119 with 0% financed with non-governmental sources. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Child Care, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

Acknowledgements

Thank you to the following individuals, organizations, and departments that provided support for the 2019 ECI Needs Assessment.

ECI Component Groups:

Executive Summary

Early Childhood Iowa’s 2019 Needs Assessment reflects a legislatively prioritized statewide emphasis on collaborative, comprehensive approaches supporting young children and their families. It builds on investments over the last several decades in quality early care and education (ECE) systems, and capitalizes on recent development of a statewide integrated data system (IDS) that brings together relevant data from siloed systems of health, education, and child welfare to use for statewide strategic planning. Using an iterative, bi-directional process this Needs Assessment included seven data collection efforts and a series of stakeholder learning sessions with diverse stakeholders including families, community members, executive leaders, private business partners, program managers, and providers. Findings were used to enhance ECI’s companion Strategic Plan, “We are ECI,” by calling attention to needs for enhanced system-wide infrastructure, communications, workforce development, family access to care, and quality improvement across our birth-to-five programming.
Data collection for the 2019 Needs Assessment included administrative data from health, education, and child welfare that was integrated across the population of birth-to-five using our IDS; family and provider surveys to gather statewide perspectives on access and barriers to care; family and provider focus groups to understand voices of our community and the systemic strengths and disconnects that need addressed; and statewide community listening sessions that identified the top five critical issues facing Iowa communities’ ability to thrive.

We have gaps in service utilization for vulnerable children including those in rural counties, low-income and minority families, and with identified risks at birth such as low maternal education or inadequate prenatal care. Our families face significant access challenges, including long waiting lists and out-of-reach costs that prevent many of them from receiving the care they need when they need it.

We have shortages in both the quantity and quality of our early childhood workforce. Staffing challenges are particularly acute in rural counties, which comprise 89% of Iowa’s counties.

We have identified gaps in communications that limit our ability to fully foster systems-wide change. Generating and improving bi-directional feedback loops with families and providers, as well as strategies to improve the content of communications, is needed.

We need to continue investments in building a “data culture” so that the information we collect to monitor the impact of our efforts is used in strategic planning and daily decision-making to improve our system.

These findings directly informed the development of a revised Strategic Plan for ECI in August of 2019. This Plan, “We are ECI,” identifies five goals and thirteen specific strategies to improve the overall coordination and quality of Iowa’s mixed delivery birth-to-five system to address these prioritized needs.

Part 1: Iowa Context and Early Childhood Systems Development

The state of Iowa is home to nearly 250,000 children under the age of six. With 21% of these young children being non-white, they represent the most diverse age group in Iowa. Iowa also has one of the highest percentages of households with young children where all available parents are in the workforce (75% compared with 65% nationally). Recognizing the need for quality, coordinated services for young children in this context, Iowa has made significant investments into its early childhood system including being one of the first states to develop a comprehensive preschool program for low-income children and implement a two-generation approach for families living in poverty in the 1980s.

In 1998, the Iowa Legislature passed a law providing funding for early childhood services through local areas boards covering all 99 counties called Iowa Community Empowerment. It also authorized a State Board (similar to a Children’s Cabinet but with citizen and legislative members) to facilitate strategic planning, governance, program coordination, and accountability. In 2009 a Stakeholders Alliance (comprised of diverse members from across Iowa’s early care, health, and education systems) was designated as the State Advisory Council on Early Childhood Education and Care as required by the Head Start Act of 2007. This systems-building work culminated in 2010 when the Iowa Legislature designated Early Childhood Iowa (ECI) the new organizational umbrella for the local boards, State Board, and the Stakeholders Alliance, thus clarifying their purpose and functions in Iowa’s early childhood system. ECI is advised by a State Board comprised of 15 governor appointed citizens, six department directors, and four legislators. It is also supported by Component Groups tasked with fulfilling the organization’s mission. As a result of its comprehensive leadership, ECI is the only systemic voice to promote child wellbeing across multiple agencies and developmental domains and to emphasize system building through local level empowerment and state-level partnerships. The law directed that the same statewide vision, results areas, and strategic plan be used throughout the entire system, ensuring coordination of efforts – a critical step for our system to address the needs of young children and their families.

The governance structure and operational functions of ECI present a unique opportunity for interdisciplinary collaborations and accountability that foster improved services for children and families. The ECI State Office is situated within the Department of Management, providing access to the Governor’s office and a neutral space for departments to consider child and family needs because work is not directed solely from a health, child welfare, or educational lens. The deliberate incorporation of public and private members on local and state committees facilitates “top-down, bottom-up” communication and decision-making. Further, the structure of the Board, Stakeholder Alliance, Steering Committee, and Component Groups articulates routine processes to facilitate system-wide changes. Overall, this ECI system attempts to break down silos and hierarchies by assuring routine communication and accountability structures.

In 2013, ECI utilized funding from an Early Childhood Advisory Council Grant to conduct a statewide needs assessment and adopt its first joint strategic plan aimed at facilitating early childhood program coordination and improving outcomes for young children and their families. This needs assessment and strategic plan described the population of Iowa families with children under age 6 and identified outcome indicators aligned with the legislatively governed Results Areas that are the focus of ECI. This assessment and plan has been updated twice since 2013, using publicly available national data (e.g., American Community Survey) and aggregate counts of characteristics and experiences from single-system state data sources (e.g., Department of Education reported counts of children enrolled in Statewide Voluntary Preschool or Department of Human Services and Public Health reported counts of home visiting slots).

While the needs assessment and strategic planning process over the last several years improved our understanding of child and family needs across the state, stakeholders recognized that it did not sufficiently inform a comprehensive birth-to-five strategic plan. Our Department of Education’s most recent Condition of Education report suggests, for example, we are not adequately serving all birth-to-five children as evidenced by the fact that only 61% of kindergartners meet basic early literacy benchmarks, and the range of proficiency across schools and for low-income and minority students is over 40 percentage points (42%-85%). Reports also suggested children are under enrolling in many of our programs, particularly those who face economic vulnerability. Nearly 35% of eligible children do not enroll in state-funded preschool programs, and only 22% of students in Statewide Voluntary Preschool Program (SWVPP) qualify for free/reduced lunch compared to 42% in the overall population. Eligibility for SWVPP is for students to be four-years of age by September 15 of the current school-year. Enrollment may include children who are younger or older as long as all four-year-olds requesting enrollment are served. These non-four-year-olds are not counted for state funding purposes.

In some Iowa counties, there are preschool slots available for children ages three through five whose families meet primary or secondary eligibility as indicated within Shared Visions. Primary eligibility for Shared Visions is met at 130% of the federal poverty level or below, based on family size. Secondary eligibility may account for up to 20% of children enrolled in Shared Visions and is based on a list of risk factors. Approximately 1,300 children, ages three through five, enroll in Shared Visions annually as this is a grant-based program and funding is limited. Additionally, approximately 6,500 young children attend Head Start.

As of 2018 we could not assess the unduplicated counts of children across these state- funded (SWVPP and Shared Visions) and Head Start preschool programs, identify how the same children were served in multiple settings (e.g., licensed or regulated/unregulated care), or identify the service patterns of income eligible children who received Child Care Assistance. To adequately address the comprehensive needs of our statewide population of children birth-to-five, we need to address pressing gaps in data about program enrollment, access for vulnerable populations, and whether or not our programs are making a difference for young children served (see Needs Assessment findings, section III, for more information).

Legislative authority within ECI (Iowa Code 256i) and the Head Start Act of 2007 (42 USC 9801 et seq.) have encouraged collaboration to develop an early childhood integrated data system (IDS). In Iowa, the development of an IDS has supported enhancements to ECI’s capacity to address some of these previously unanswered questions. In 2013, Gold Systems Inc. of Salt Lake City, Utah, was contracted to develop a framework for an early childhood data system using funds from the Early Childhood Advisory Council Grant. Results of the Gold Systems report were used to incorporate the development of an IDS into the ECI Strategic Plan in 2015. A Board-appointed IDS Taskforce (subcommittee of the Results Accountability Component Workgroup) developed plans for IDS development with support from two nationally competitive training and technical assistance grants from the Annie E. Casey Foundation (through Actionable Intelligence for Social Policy; www.aisp.upenn.edu) and Third Sector Capital Partners. This Taskforce met biweekly for two years to solidify Iowa’s mission and vision for the IDS, update data inventories and identify priority areas, and establish a State-University Partnership governance structure to guide IDS procedures and ensure existing data are used to improve programming and outcomes. These partnership-building efforts across departments and with Iowa’s land-grant University (Iowa State University) have accelerated ECI’s capacity for collaborative data analytics to realize the intent of the 1998 ECI legislation to create an effective, efficient and coordinated birth-to-five system.

Part 2: Approach to the 2019 Needs Assessment

The purpose of ECI’s 2019 Needs Assessment was to address gaps in understanding Iowa children and families from birth-to-five on key issues related to early care and education (ECE) capacity, knowledge and access, supporting children with special needs, transitions, and collaborations. Our process involved strategic engagement of diverse stakeholders across the ECI system in iterative, bi-directional communications that reinforced ECI’s unique governance structure and collective approach, as embodied in the companion 2019 Strategic Plan “We are ECI.” The process also involved testing the value of our emerging Integrated Data System (IDS) as a sustainable infrastructure to support data-enriched governance and evidence-based policy-making adhering to ECI guiding principles of equity, quality, privacy and accountability. The following summary outlines our communications and infrastructure development processes, key definitions and terms used to guide data collection, and the primary methods used.

Process

Our iterative, bi-directional process of learning throughout this Needs Assessment involved collective input from diverse stakeholders including families, community members, executive leaders, private business partners, program managers, and providers (see Figure 1). This iterative process involved the full range of input including types of questions asked, relevant data collected, and findings gleaned from the data analyzed. This process helped keep people informed of the goals of the Needs Assessment, drive data collection decisions (e.g., nature and scope of family and provider surveys and focus groups), build infrastructure tools (e.g., IDS datasets and integration protocols), and explore and refine key results. The effort sought to not only gather relevant input, but also to facilitate continued improvement in data literacy among the ECI community.

In addition to maximizing ECI’s wide stakeholder engagement and communications networks, our Needs Assessment capitalized on recent investments in an IDS as a sustainable resource for gathering and analyzing information about Iowa children and families. ECI’s IDS facilitates collaboration with executive leadership and program providers to harness and integrate siloed administrative data sources. Integrated data has the capacity to understand, for the first time, unduplicated counts of children with preschool experiences as well as document how vulnerabilities at birth are linked to child wellbeing in kindergarten. The resulting expansion of ECI’s data infrastructure transforms how our system utilizes existing data to improve operations, service delivery, and decision-making as well as supports rapid dissemination of findings to our stakeholder network. Through the early testing and refinement of the IDS we have created a system that promotes ECI principles of equity, quality, privacy, and accountability. For example, to ensure ethical standards that value representation of all children without bias, we tested and improved data integration algorithms in the IDS. We also established data quality standards that not only supported the Needs Assessment results but also support data literacy and data improvement conversations with departments, programs, agencies, and families in the future. Throughout this process we tested and improved privacy protocols to ensure our IDS meets or exceeds national standards for secure data use. By carefully documenting IDS procedures and processes, as well as communicating our findings regularly with stakeholders, we are fostering improved accountability for data to be used to support ECI’s mission.

Culminating from the data collection and analysis efforts was a series of inter-departmental meetings, stakeholder learning sessions, and statewide webinars to discuss results and future plans. After a first round of preliminary analyses were shared and discussed with leaders across Iowa Departments of Education, Human Services, and Public Health, two all-day learning sessions were held with invited members from the Stakeholder Alliance. At each session, data was shared and then reflected upon. A professional facilitator elicited opinions and feedback on the Needs Assessment findings to help ECI refine and understand the most pertinent issues. Learnings from these sessions were then incorporated into an all-day strategic planning session, where teams discussed how they might use the data generated to (a) refine elements of the current strategic plan and (b) develop new goals and strategies that directly relate to the Needs Assessment findings. The refined results from the learning sessions are reflected in the data presented in this report and in the content and framing of the companion strategic plan, “We are ECI.”

Key Terms and Definitions

Vulnerable children: Children experiencing family poverty; homelessness; child welfare involvement; maltreatment; birth to a teen parent; parent without a high school diploma, with identified substance abuse or mental illness, or who is illiterate or incarcerated; children with disabilities. Source: combined from Head Start, CCDF, Shared Visions, Early ACCESS, ECSE

Underserved children: Children who might qualify for services but are not enrolled, likely including disproportionate numbers of minority children (including immigrant or refugee families), children living in rural areas, and those with disabilities. Source: Early Childhood Iowa

Children in rural areas: Iowa has 88 rural counties (out of 99), assessed as geographic units outside of urban areas (census block groups that have a population density of 1,000 people per square mile). Source: US Census Bureau; Woods & Poole (2017)

Quality early care and education (ECE): Based on federal and state standards for program accreditation and quality ratings. These often include multiple physical, economic, and cultural dimensions. Source: NAEYC, NAFCC, QRIS, QPPS, FSC

Availability of ECE: Based on the national estimates of child care deserts, calculated as the ratio of the number of age-eligible children divided by the number of possible slots across providers (not to exceed 3-to-1). Source: Center for America Progress

Birth-to-five mixed delivery system: comprehensive services across health, mental health, nutrition, family support, and home- and center-based environments that are inclusive of vulnerable children including those with disabilities, offered by a variety of programs and providers supported with a combination of public and private funding. Source: Early Childhood Iowa

Notes: Child Care Development Fund (CCDF), Early Childhood Special Education (ECSE), National Association for Education of Young Children (NAEYC), National Association for Family Child Care (NAFCC), Quality Rating Improvement System (QRIS), Quality Preschool Program Standards (QPPS), Family Support Credential (FSC).

Data Collected

In support of ECI’s institutional goal to improve outcomes for children, we sought the expertise and insights of families, providers, administrators, and community members iteratively and in multiple formats. While our IDS was included as one of these sources, we recognize limitations of administrative data and deliberately incorporated voices of families and providers in the Needs Assessment effort through surveys, focus groups, and community listening sessions. Whenever possible, vulnerable and underserved populations were over sampled including rural families, families with children with special needs, immigrant families, and fathers. For each type of data collected, every effort was made to produce geographically representative samples, reflecting each of ECI’s 38 local areas, and the 88 rural and 11 urban counties in Iowa. A mixed-method research design afforded a range of qualitative and quantitative feedback regarding how our state and local programming might better serve the needs young children and their families. See Table 2 for an overview of the research methodology, sample representativeness, and type of data collected, and Appendices A-E for a detailed description of these data collection efforts.

Table 2: DATA METHOD, REPRESENTATIVENESS & DESCRIPTION

Document Review Description: Collected and summarized state documents, reports, evaluations, and existing needs assessments from all state departments with programs serving young children.

Method: Documents were compiled between February and March 2019 by the Early Childhood Iowa (ECI) Preschool Development Grant Core Team with feedback from the ECI Steering Committee and Results Accountability Component Groups.

Representativeness: Included significant reports of early childhood services and programs generated within the last ten years. A full list of the documents reviewed is provided in the References section and described throughout in Part III of this Needs Assessment.

Integrated Data System Description: Data reflecting child and family characteristics and program participation were analyzed to answer questions about who ECI serves and where there are gaps for vulnerable and underserved families.

Method: Administrative records from the Departments of Public Health, Human Services, and Education were integrated at the child level to create a cohort of 27,321 children who were born in Iowa and enrolled in kindergarten in Iowa during the 2017-2018 school year.

Representativeness: Included all children who were born in Iowa and were eligible to or did attend kindergarten in 2017-2018.

Provider Survey Description: These data included information on several child care attributes such as QRS level and whether the center is an active CCA provider.

Method: Survey data were electronically collected from 591 licensed child care centers (of 1220 targeted centers) between April and June of 2019.

Representativeness: The sample represents 93 of the 99 Iowa counties and provides a representative cross-section of QRS & CCA participation and program type.

Family Survey Description: Respondents were asked about experiences with an array of early childhood programs, including family knowledge, use, and barriers of access to birth-to-five services.

Method: Survey data were electronically collected from 546 Iowa families between May and June of 2019 and include respondents from 77 of Iowa’s 99 counties. Families were recruited via email, with an anonymous survey link, from multiple ECI organizations and affiliated agencies.

Representativeness: Families that completed the survey had slightly higher education levels than typical Iowa families and overrepresented families that had children with disabilities.

Provider Focus Groups Description: Focus groups were asked about providers’ experiences working with families, workforce and professional development, and partnerships between programs to support transitions and collaborations.

Method: Data were collected from 10 service provider focus groups between May and July of 2019.

Representativeness: Participants were recruited by local ECI boards to reflect a range of health, education, and home and center care service providers. Participants were geographically distributed throughout the state.

Family Focus Groups Description: Focus groups were asked about families’ experiences with the Birth-to-five system, including attention to barriers and transitions.

Method: Data were collected from 13 family focus groups between May and July of 2019.

Representativeness: Participants were recruited by local ECI boards to include families with a range of health, education, and child care experiences and were geographically distributed throughout the state.

Community Listening Sessions Description: Community members and local leaders reported that the top five issues to impact Iowa’s ability to thrive were child care, mental health, housing, workforce, and the farm economy. Child care responses highlighted concerns with access, affordability, quality, and support of providers, among other topics.

Method: Data were collected from approximately 1,200 participants across 62 statewide listening sessions held in 21 communities between June and December 2018. Early childhood themes were identified using NVivo qualitative software in May through July of 2019.

Representativeness: Participants were geographically distributed throughout the state, reflecting each of Iowa’s 20 Community Extension Service regions.

Part 3: 2019 Needs Assessment Findings

The comprehensive Needs Assessment conducted in 2019 included six data collection efforts and a substantive review of existing state reports, needs assessments, and strategic plans. The References section includes each report that was reviewed as well as additional materials used to understand Iowa needs and service utilization across the birth-to-five mixed delivery system. Appendices A through E provide full technical reports of each data collection effort.

The following narrative summarizes the information learned across four priority topic areas: describing Iowa’s children birth-to-five, Iowa’s early childhood capacity and access, early care and education quality in Iowa, and Iowa’s workforce capacity and professional development. Each topic area is summarized in three sections: (a) a review of findings from prior reports; (b) specific findings from data collected during this Needs Assessment, and (c) prioritized needs based on stakeholder feedback at the learning sessions that reviewed Needs Assessment findings and included discussion of opportunities for strategic planning.

Who are Iowa’s Children?

Summary of Prior Reports.

Despite having one of the top high school graduation rates in the US (over 91%), Iowa’s standardized achievement results for school-aged children have recently stagnated or even begun to show declines.8 Achievement gaps are growing across grades, with proficiency disparities up to 33 percentage points for Black students relative to white and Hispanic students and gaps of 22 percentage points for students qualifying for free/reduced priced lunch relative to their peers. These trends begin in early childhood, where only 61% of children meet basic literacy benchmarks at kindergarten entry, with rates for Hispanic, Black, and low-income students up to 20 percentage points lower than their peers.

The 2018 ECI Needs Assessment 1 provided an overview of key indicators of wellbeing for children under age 6 and their families (see Table 3). The report also highlighted three important demographic trends: First, the percentage of non-white children under age 6 continues to grow from 12% in 2000 to nearly 20% by 2018, with increases in Hispanic children outpacing other groups. Second, although unemployment rates fluctuate, the percent of young children in poverty remains steady, with nearly one-third of families reporting incomes below what households need to afford basic necessities 17 and over 40% of kindergartners qualifying for free or reduced priced lunch.8 Third, Iowa’s population continues to move into urban areas, and decreasing proportions of young children are living in the 88 rural counties (89% of all 99 counties). As this migration occurs, rural counties are losing resources such as jobs and child care, and school consolidations increase our challenges in transportation.

Table 3. Child and Family Indicators from the 2018 ECI Needs Assessment

Households with children < 6 with all parents in the workforce 75.0% Decreasing US Census

Families with children under 6 headed by single parent 25.6% Increasing US Census, American Community Survey 5-year Estimates

Children on Medicaid with at least 1 EPSDT Exam (i.e., well child visits) 82.0% Decreasing Iowa Department of Human Services

1b. Results of New Data Collected.

A number of data collection efforts were undertaken to supplement the existing statewide assessment summarized above. In particular, we developed and tested an integrated data system (IDS) to provide a more nuanced understanding of a cohort of children born in the state who enrolled in kindergarten in 2017-18, with a specific focus on the experiences of vulnerable and rural populations. This approach provided a comprehensive picture of children’s characteristics and risk exposure at birth, preschool enrollment, use of Child Care Assistance during the year prior to kindergarten, and a subset of kindergarten indicators including attendance rates, Individualized Education Plan (IEP) status, and suspension history. A full report with technical details about the IDS data collection, analysis, and findings can be found in Appendix B.

The following is a summary of major findings from the 2019 ECI-IDS cohort study:

Risk experiences of Iowa children

59% of Iowa’s children experience at least 1 risk at birth that is known to significantly influence kindergarten outcomes. Risks included poverty, low maternal education, birth to a teen mother, birth to a single mother, inadequate prenatal care, preterm/low birth weight, or smoking during pregnancy.

Rural and minority children experience more individual and cumulative count of risks at birth compared to other children.

Child outcomes

Vulnerable populations that are more likely to evidence poor kindergarten outcomes include: children born in low-income families; children born to unmarried, low educated, or teen mothers; children of minority racial status (i.e., Black, Hispanic, Asian, or multiple races); and children whose mothers smoked during pregnancy.

Boys were significantly more likely than girls to have identified needs for special education (i.e., an IEP) and to be suspended from school in kindergarten.

1c. Prioritized Needs Identified by ECI Stakeholders.

Needs Assessment findings were digested and discussed by diverse stakeholder groups in over a dozen meetings with department leaders, program managers, families, community leaders, and providers, as well as during ECI sponsored Learning Sessions. Throughout this process, several prioritized needs were identified to support ECI’s system transformation work. The following summaries, in conjunction with the above findings, were used to inform ECI’s Strategic Plan: “We are ECI.”

A pervasive theme identified was the need for more effective formal and informal communications strategies to ensure that relevant information is communicated in culturally appropriate ways and to the people poised to make changes. This included explicit attention to engaging Iowa’s business community in the state’s early childhood transformation efforts.

Stakeholders noted that families need greater outreach and engagement in order to support the regular, daily school attendance of kindergartners. Further, this outreach should be part of a system-wide education campaign to involve families as leaders in systems change that begins as early in a child’s life as possible. This message includes that school (and ECE) attendance is strongly linked to other achievement and wellbeing outcomes, and attendance is associated with numerous risks at birth, suggesting the timing for intervention extends throughout birth-to-five.

Persistent disparities in educational outcomes for low-income and ethnic/racial minority children are a challenge in Iowa, and stakeholders agreed that continued emphasis on supporting equity in the access of care and child developmental outcomes is needed.

Stakeholders pressed for more discussion about identifying “leverage points” in the system to better meet the needs of vulnerable and underserved populations. In light of findings documenting how certain birth risks predict kindergarten outcomes, intervention programs could prioritize mothers without high school degrees or whose children did not have adequate prenatal care for additional or specialized services.

2. Early Care and Education Capacity and Access

2a. Summary of Prior Reports.

Iowa’s birth-to-five mixed delivery system includes comprehensive services, multiple service delivery options, and funding from local, state and federal sources. While the system prioritizes services for vulnerable and underserved children, the 2018 ECI Needs Assessment results suggest that we continue to have gaps for certain groups including ethnic minority and low-income children.

Family Support programs are coordinated by the Iowa Department of Public Health but represent its own mixed delivery system with multiple funding sources and multiple service models. In FY2017, this blended funding structure supported nearly 135,000 home visits to over 14,000 families through the state ECI, IDPH, and DE funds (10,700 families); Department of Human Services prevention funds (1,500 families); Department of Human Rights (3,000 families); federal funds from Early Head Start (1,000 families); and federal funds from the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV; 900 families).26 Together, these programs serve nearly 15,000 children, but this is only 8% of Iowa’s total population of children under age 5.

Early care and education (ECE) in Iowa includes a blend of public and private providers, universal and targeted programs, home- and center-based options, and subsidized care. Preschool (i.e., age 3-4) programs included in Iowa’s Every Student Succeeds Act plan require use of Iowa’s Early Learning Standards to support quality, developmentally appropriate education.

Head Start, a federally funded program for low-income children, has operated in Iowa since 1965, and is currently administered by 19 grantees (including one Migrant and Seasonal Head Start) serving 6,500 preschool-aged children. Early Head Start provides services to approximately 2,000 children aged birth-3, 800 in home-based models and 1,200 in center-based models (including through child care partnerships).

Iowa was one of the first states in 1988 to implement a comprehensive, targeted state-funded (Department of Education) preschool program for low-income children, named Shared Visions. This program offers care to over 1,300 children in 37% of Iowa’s 99 counties. In partnership with the Iowa Department of Human Services and local licensed child care providers, nearly 70% of these children participate in wrap around care that enables them to receive 7 hours or more of care and early learning per day.

Statewide Voluntary Preschool Program (SWVPP), funded by the Iowa Department of Education, began in 2007 and provides a minimum of 10 hours per week, part-day preschool in public schools (or community settings through contracts) at no charge for any 4-year-old, and serves nearly 25,000 children in 98% of school districts. Yet, numerous indicators suggest that SWVPP does not reach large percentages of Iowa’s more vulnerable children. According to parent reports collected at kindergarten enrollment, for example, 82.5% of children have attended some type of preschool program.8 Children enrolled in SWVPP are also less likely than children enrolled in kindergarten through 12th grade to be of color (21.8% vs. 24.3%), to be English language learners (2% vs. 6.1%), or to qualify for free or reduced price lunch (22% vs. 41%).

Regulated Child Care Facilities include private sector options to complement state- and federally-funded programming. These include 2,641 registered child care homes and 1,530 licensed child care centers. Most of this care is funded by families, but Child Care Assistance is available for families under 145% of the federal poverty line (FPL) with provisions for additional support when families transition above this threshold to extend benefits up to 12 months [(paid by Child Care Development Block Grant (CCDBG), Temporary Assistance for Needy Families (TANF), and other state funds]. The CCDBG is a federally funded program with the purpose to help subsidize childcare costs for low income families. Every state determines its reimbursement rate and Iowa utilized the 2017 Market Rate Survey to determine current payment rates. According to DHS, in FY2018 Iowa saw a historically high increase of $19.3 million funds to the CCDBG, allowing more high quality ECE providers the ability to have the costs covered from families receiving the subsidy. Through implementation of CCDBG requirements, Iowa increased provider reimbursement rates through a tiered payment program with QRS, moved from 6 to 12 month family eligibility, and implemented a graduated phase out program. Average childcare costs for one child per year in Iowa is $10,131, higher than in-state public tuition for postsecondary education. Infant childcare costs for a single parent in Iowa making the state’s median annual income can average as much as 40% of total income. Through the raise in CCBDG funding, the idea was that families and child care providers would be positively impacted as families have more higher quality childcare options and the extra funds for the providers has potential to increase wages, and making it easier to recruit and retain high quality staff. The effect of this implementation, however, has yet to be tested.

Unregulated Care. While Iowa has a robust early childhood system, we must not ignore the fact that there are other types of programming that parents may choose to utilize that are exempt from licensing or regulatory requirements. Iowa permits child care homes in which a provider is caring for no more than 5 children at any one time to operate without regulation. (Iowa Code 237A.) Given that parents are often overwhelmed or lack knowledge on the system as a whole, there is concern that parents seek unregulated care when they (a) lack access to regulated care; (b) are unsure of what to look for; or (c) operate under assumption that all programs have regulatory oversight. Because there is a lack of oversight, we are unable to determine whether these are safe environments, let alone quality environments.

Services targeted to children who have an identified disability are provided under the Individuals with Disabilities Education Improvement Act (IDEA). In 2016 Early ACCESS provided early intervention services to 6,221 (2.5% of the population) children, between birth and age 3, who have an identified disability or are at risk for developmental delay, and their families.1 Another 6,976 (5.6% of the population) children between ages 3 and 5 received early childhood special education services in 2016. The proportion of Iowa children receiving IDEA services is well below national averages. Across the U.S., 3.1% of children birth to 3 and 10.4% of children between 3 and 5 receive these services.

Child care deserts are defined as a “census tract with more than 50 children under age 5 that contains either no child care providers or so few options that there are more than three times as many children as licensed child care slots”. According to the Center for American Progress, 23% of Iowa is in a child care desert. Rural and low-income families are especially affected by the low number of child care programs. Among children living in child care deserts, 35% live in rural areas and 24% are from low-income families. According to a 2018 report by Iowa Child Care Resource and Referral, there has a been a 42% drop in total child care programs in the state since 2013 (including child development homes, child care centers, unregulated child care homes taking Child Care Assistance (CCA), and those unregulated child care homes that CCR&R is aware of), and a 46% drop in recent years in total programs that report accepting Child Care Assistance.

In addressing the large drop in total number of child care programs and those that report accepting CCA, the Department of Human Services reports that a decrease in unregulated providers eligible to receive CCA with a Provider Agreement (CCA PA) is related to an increase in regulations from CCDBG. Prior to implementation of additional healthy and safety requirements, professional development requirements, and annual inspections, this population self-certified compliance with low regulations. The Department conducted an evaluation of unregulated child care homes with a CCA PA who were not serving children and closed out those providers that were inactive for a period of time. As a result, the number of providers and perceived available slots dropped quickly. Regulatory requirements and inspections were fully implemented in 2016 and since then, we have continued to see a decrease in this specific provider population.

2b. Results from New Data Collected. Additional data were collected and analyzed in 2019 for the current Needs Assessment to supplement our understanding from existing reports summarized above. Extensive details are provided in the Appendix of this document and include IDS data (Appendix A), Provider Survey (see Appendix B), Family Survey (see Appendix C), and Family and Provider Focus Groups (see Appendix D). Four primary questions guided the data collection and analysis for this area: (a) what are the unduplicated counts of children in preschool programs during the year before kindergarten; (b) who are underserved populations that are less likely to participate in center-based programs the year before kindergarten; (c) what is the nature and extent of waiting lists for DHS licensed centers; and (d) what are the biggest barriers families report to accessing care (with a broader focus not just on ECE but on the range of birth-to-five care opportunities)?

The following is a summary of findings about Iowa’s ECE capacity and access:

Unduplicated counts

After determining duplicated counts of children across program types using our IDS, we found that 73% of children in the IDS cohort study had at least one documented, formal center-based experience (of any type) during the year before kindergarten entry.

Underserved and vulnerable populations

Underserved populations who were less likely to have a formal, center-based preschool experience the year before kindergarten included Hispanic, Black and multiracial children; children born to unmarried mothers or mothers without a high school education; and children with inadequate prenatal care.

While our Child Care Assistance program was found to reach proportionally some of our vulnerable and minority populations during the year before kindergarten (including Black, multiracial, and low-income families), disproportionate gaps were found for children born to mothers without a high school education and those with inadequate prenatal care.

Child care center waitlists were reported as comprising 77% and 40% of the total enrollment of infant/toddler and preschool classrooms, respectively (i.e., if an infant/toddler center had 100 children enrolled then they also reported a waiting list of 77 more children).

Child care centers reporting waiting lists disproportionately reported they were also not enrolled at full capacity (57% for infant/toddler programs and 60% for preschool programs).

Child care centers with enrollment numbers below capacity indicate that one of the primary reasons was an inability to hire staff; centers from rural areas were more likely to report this challenge compared to centers in urban areas.

Families reported barriers to access

An overarching theme from provider and family surveys, focus groups, and community listening sessions was “access to care when families need it” is one of Iowa’s top challenges. Families report making less-than-ideal choices for care because they feel they lack options that meet their needs at the times they need it.

Families report the primary barriers to ECE services are waiting lists (54%) and cost of care (34%), with nearly one quarter of families also reporting that ECE programs do not meet their needs or they have barriers in transportation.

Despite access challenges, families report high levels of knowledge about ECE services including early learning and center- and home-based child care (above 90%), with relatively less awareness of services for children with special needs (80%), home visiting and dental services (78%) and job skills support (71%).

Families have access to technology and the internet, with 99% reporting at least one smartphone in their household.

In times of crisis families report relying heavily on friends and family networks (95%) with very few using the internet or social media to find help (12%).

2c. Prioritized Needs Identified by ECI Stakeholders.

Needs Assessment findings were digested and discussed by diverse groups in over a dozen meetings with department leaders, program managers, and providers. They were also discussed in Learning Sessions with broad ECI stakeholder participation where several prioritized needs were identified to support ECI’s system transformation work. The following summaries, in conjunction with the above specific findings from the Needs Assessment, were used subsequently to inform ECI’s Strategic Plan: “We are ECI.”

We need to expand ECE accessibility for families, by both increasing the number of “slots” and figuring out ways to prioritize getting our most vulnerable children access to slots that are available.

More partnerships are needed to connect our universal preschool program (SWVPP) with additional care options including wrap around care and transportation to better meet the needs of working families.

We need to invest in stronger formal and informal communication networks. Parents need more (and better quality) information regarding available services and the level of quality of the programs from which they can choose.

Programs need to better support families through the use of coordinated intake processes to connect children and their families with necessary services. This will better support families in accessing high-quality programs with one entry point rather than having to replicate eligibility and enrollment processes at multiple points across the system.

3. Early Care and Education Quality

3a. Summary of Prior Reports.

Iowa has invested in quality improvement efforts across our ECE system including development and implementation of a statewide Quality Rating System (QRS), as well as promoting participation in national accreditation and program performance initiatives through the National Association for the Education of Young Children (NAEYC).

Iowa measures quality by examining participation in the QRS system as well as the number of center-based programs that use one of three program standards recognized by the Iowa Department of Education: NAEYC Accreditation, the federal Head Start Program Performance Standards (HSPPS) and the state-developed Iowa Quality Preschool Program Standards. According to the 2018 ECI Annual Report,2 125 of Iowa’s early learning environments were accredited by the NAEYC and fewer than 10 of regulated child development homes were accredited by the National Association of Family Child Care (NAFCC).

The Iowa QRS is a voluntary program created in 2006 by the Iowa Department of Human Services (DHS) with the intent to encourage high-quality childcare throughout the state and better inform families about what constitutes quality The 2016 Iowa Department of Public Health (IDPH) Title V Needs Assessment Report indicated that about 50% of licensed childcare centers and 14% of registered in-home providers are rated through the QRS.15 As of June 2019, there were a total of 721 licensed child care centers rated with Iowa’s QRS, with 67% of those rated as a 4 or higher. Programs in rural areas are more likely to participate in the QRS and have higher ratings.16 In 2018, the total number of Head Start classrooms with a QRS rating increased from 56 to 66, the highest number in the past seven years. However, this is still only 26% of all Head Start classrooms.

As summarized in the most recent report and five-year plan from the Iowa Head Start Collaboration Office, Iowa’s QRS system could encourage participation in quality improvement by recognizing other measures of ECE quality. The Iowa Head Start Association is working with DHS to encourage higher participation in the revised QRS system when it is released (per Head Start Program Standards, 1302.53(b)(2).20 The new version will be using Head Start quality indicators as part of its assessment, and Head Start programs will receive consideration for quality measures they currently meet by being Head Start programs. Currently, many NAEYC accredited programs do not participate in QRS, because it seems to them duplicative of time and effort. Iowa’s new Quality Rating and Improvement System, known as Iowa Quality For Kids (IQ4K) will address some of these concerns. In the IQ4K System, programs operating under an accreditation or other recognized professional performance standards will not be required to duplicate criteria in IQ4K that they are already practicing as part of their accreditation/performance standards. Those programs will only be required to complete IQ4K criteria that they are not already doing as part of their accreditation or performance standards.

As of 2018, regulated child development home providers and center directors report that the small financial incentives for participating in the QRS do not outweigh the additional financial costs needed in order to meet the requirements. This corroborates sentiments reflected in the 2016 Iowa ECE Workforce Study that suggested additional types of incentives, such as access and qualification for grants or an allowance to join publicly sponsored programs, would be beneficial in making the QRS a more desired qualification to obtain and maintain.

As reflected in one of ECI’s priorities and encouraged through federal legislation in the Every Student Succeeds Act and the Head Start Act, Iowa ECE providers often seek to address program access and quality through the establishment of partnerships using written agreements across programs to facilitate shared resources and provide enhanced training and collaboration opportunities. As evident in the 2018 Iowa Head Start Needs Assessment,6 collaborations between Head Start and local education agencies (LEA) is one way this can be addressed. As of 2018, Head Start grantees reported having no collaboration with 47.8% of Iowa’s 330 school districts. Though Head Start programs are only operating in 130 of those districts. Head Start grantees also reported that for the 70% of districts that grantees had established communication and coordination with, it was “not at all difficult”,6 suggesting that opportunities for fostering similar partnerships may exist in other districts. Head Start and LEAs use variety of collaborative models, including coordinated enrollment, fully infused classrooms (Head Start and non-Head Start children in the same classroom), and ‘Flip the Switch’, where the same cohort of children participate in Head Start and a district classroom at different times during the same day using consistent curriculum and sometimes staff for both parts of the day. The 2018 Head Start Collaboration plan emphasizes expanding partnerships with LEAs, and other community and state partners to improve quality, and provide working families with full-day services.

Overall, many early childhood programs across the state are highlighting the need for increased knowledge of and participation in collaborative quality improvement measures and efforts, including professional development and wage increases for the workforce. There is a need to build bridges between sectors in order to improve the quality of early childhood care for families across Iowa.

3b. Results of New Data Collected.

Two primary questions guided data collection and analysis for this area: (a) what is the relative quality of providers who serve our most vulnerable populations; and (b) what are the biggest barriers centers report to improving the quality of care? Additional details on these data collection efforts and findings are provided in the Appendix of this document. Information was collected to add to our understanding of the quality of our ECE system from a Provider Survey (see also Appendix B), Family Survey (see also Appendix C), and Family and Provider Focus Groups (see also Appendix D).

The following is a summary of 2019 Needs Assessment findings about Iowa’s ECE quality:

Program quality

Of those ECE centers that participate in QRS, the QRS levels of programs that accept Child Care Assistance (CCA) are overall lower than QRS levels of all licensed centers.

Of those ECE centers that do not participate in QRS or other accreditation programs (e.g., NAEYC), the primary reasons reported were because of staffing barriers and time constraints.

21% of centers that did not currently accept CCA reported that knowledge of the rate increase would change their willingness to accept children with CCA.

More rural centers (versus urban) and those that accept CCA (versus those that do not accept CCA) reported working partnerships with Iowa’s Statewide Voluntary Preschool Programs such that children participate in both programs and/or that programs share space, staff, or other financial resources.

Three times as many rural centers (compared to urban centers) report partnerships with Head Start programs that facilitate children attending both programs.

Families report higher levels of met need in Medicaid, home visiting, early learning (centers), dental, and services for children with special needs (i.e., over 90% report these services “met their needs”) compared to programs for job skills support (77%), housing assistance (80%), and home-based or center-based child care (83%).

Program reported barriers to improving quality

41% of administrators from Iowa Department of Human Services (DHS) licensed centers report concerns with their facilities that impact program quality, with over 50% of them reporting concerns with insufficient indoor gross motor space and/or concerns about the outdoor environment (size or quality).

3c. Prioritized Needs Identified by ECI Stakeholders.

Needs Assessment findings were analyzed and discussed by diverse groups in more than twelve meetings with department leaders, program managers, and providers. Findings were also discussed in two full-day Learning Sessions with broad ECI stakeholder participation to identify prioritized needs to support ECI’s system transformation work. The following summaries, in conjunction with the above specific findings from the Needs Assessment, were used subsequently to inform ECI’s Strategic Plan: “We are ECI.”

Overall, families report that quality is “moot” when they do not have access. Without tackling the access issues, improvements in program quality will not have the impact on statewide child outcomes and family wellbeing that we need.

Systematic disconnects continue to prevent programs from improving quality that include barriers in communication between department leadership and the “boots-to-the-ground” workers who provide daily care and education for our children.

Though we identified some relative strengths in program partnerships in our rural areas and between some Head Start grantees and their LEAs, we need to continue to build public will, vision, and incentives to cultivate these types of relationships using “effective ingredients” to improve the quality of the system as a whole.

While some partnerships may exist among programs to facilitate transitions between programs or between ECE and kindergarten, families do not often have sufficient information about what programs to access next, what procedures have to be followed to make these transitions and how the transitions themselves can be an abrupt and confusing experience for which they have had little preparation.

4. Early Care and Education Workforce and Professional Development

4a. Summary of Prior Reports.

With funding from the W. K. Kellogg Foundation and in partnership with Iowa Association for the Education of Young Children (Iowa AEYC), Child Care Services Association (CCSA) conducted a statewide survey of the early care and education workforce in Iowa in 2016.16 The study collected basic information about salaries, educational attainment, and demographics from directors, teachers and assistant teachers in 358 licensed ECE programs. Center information included turnover rates, wages, paid benefits and nonpaid benefits.

Findings from the 2016 Workforce study identified two major challenges: (a) the majority of Iowa’s ECE workforce has low educational attainment, and (b) low wages hinder the ability to recruit and retain high-quality staff. Specifically, 74% of the workforce was identified as having some college or less, with only 16% of the total workforce having an ECE degree. Program requirements for education and training varied, with nearly one fourth (23%) of programs without requirements for specific educational level/background. Although 53% of programs reported an educational requirement of a minimum of high school diploma or general equivalency diploma (GED), and only 23% of programs require teachers with an associate degree or above. ECE workforce wages in Iowa mirror national challenges, where teachers’ and teacher assistants’ compensation is far lower than their public school counterparts sometimes as much as one-half the average salary. In fact, the median income level for ECE educators in Iowa was below the estimated cost of living.

We also have ECE workforce needs in our programs designed to serve the most vulnerable populations. Recent Head Start needs assessment results that informed the state’s Head Start Collaboration Plan5 revealed a gap in connections between Head Start grantees and Iowa’s institutes of higher education. While many of these grantees have partnerships with local school districts to provide braided funding opportunities and even share staffing, these reports revealed that nearly one-third of grantees in the state do not have a working relationship with four-year higher education institutions, and approximately one-fifth do not connect with community colleges, creating potential gaps in capacity to recruit college-educated ECE staff and address training needs through college education.

Iowa has invested in several workforce development programs including T.E.A.C.H. EARLY CHILDHOOD®, WAGE$, and PAEYS to help alleviate the identified financial and educational gaps in the ECE workforce. T.E.A.C.H. EARLY CHILDHOOD® is a comprehensive scholarship program that provides the early childhood workforce access to educational opportunities and is helping establish a well-qualified, fairly compensated and stable workforce for our children. To further support compensation for an individual child care provider there is also a salary supplement program, known as Child Care WAGE$ Iowa (WAGE$). This program is based on individuals’ formal education and commitment to their program. Both T.E.A.C.H. and WAGE$ are licensed programs of Child Care Services Association. For MIECHV funded family support professionals, the Performance and Education Yield Success (PAEYS) program provides salary supplements based on formal educational attainment and performance.23According to the Iowa 2018 Child Care WAGE$ annual report, in FY2018 there were a total of 12 funders assisting 34 counties across Iowa.22 It is recognized that there are 65 counties still in need of WAGE$. Within counties benefiting from this program 64% of WAGE$ recipients increased their formal education in FY2018. The 2018 T.E.A.C.H. Early Childhood Iowa annual report represented formal education outcomes for 397 early childhood educators who participated. Of these scholarship recipients, 105 participants obtained a Child Development Associate (CDA) CredentialTM or higher which reflected an increase from 2017. This includes partnerships from 33 Iowa colleges and universities as we increase the early childhood care and education and family support professionals’ formal education towards degree attainment in related fields.

Iowa supports nationally licensed comprehensive scholarship programs that endorse evidence-based strategies to increase the skill and competence of the early childhood workforce. T.E.A.C.H. program participants have a 95% retention rate which increases the continuity of care and education for the young children served. Formal education, coaching supports, and retention of the early childhood workforce impacts quality. Recent attention to gaps in workforce quality for programs accepting child care assistance (CCA) included a reimbursement increase for those programs participating in the Iowa Quality Rating System (QRS). As of January 1, 2019, Iowa legislation (HF501) implemented a new tiered reimbursement increase for licensed center-based and licensed home-based programs to incentivize participation in QRS.25 No evaluations of the impact of this rate increase have been done to date.

4b. Results of New Data Collected.

Additional data were collected and analyzed in 2019 specifically for the current Needs Assessment to supplement understanding of Iowa’s ECE workforce and professional development needs. Additional details on these data collection efforts and findings are provided in the Appendix of this document. Information was collected from a Provider Survey (see also Appendix B), Family Survey (see also Appendix C), and Family and Provider Focus Groups (see also Appendix D). Two primary questions guided data collection and analysis for this area: (a) what are the workforce barriers noted by ECE centers that prevent them from enhancing program quality; and (b) what are the highest priority professional development needs of ECE providers?

The following is a summary of 2019 Needs Assessment findings about Iowa’s ECE workforce:

Insufficient ECE workforce capacity

For the 57% of centers that report enrollment below licensed capacity, one-fourth of them report a primary reason is inability to hire staff.

The inability to hire staff was cited twice as often in rural centers compared to urban ones (32% versus 16%); and eight times as often in centers that serve children with CCA compared to centers that do not accept CCA (37% versus 4%).

Provider retention was highest in rural centers, with centers reporting that 89% of teachers in rural areas are retained for 12 months or more compared with only 79% of urban providers.

Retention was lowest in centers that accept CCA, where only an average of 77% of teachers are retained for 12 months or more.

Providers overwhelmingly report challenges in wages and benefits as barriers to improving workforce capacity and quality.

Families report increased access challenges when their children attend centers with workforce turnover or they are forced to choose poorer quality care options because the current center is not able to find or retain staff.

Families report challenges in their personal employment, both finding and keeping a job, when they face child care access or quality barriers.

Providers need professional development

Providers in rural areas and those that accept CCA report overall lower education levels than urban providers and those that do not accept CCA. That is, fewer teachers have college or graduate degrees.

Families and providers share concerns about inadequate training of staff to address mental health and working with children with special needs.

4c. Prioritized Needs Identified by ECI Stakeholders.

As Needs Assessment findings were analyzed and discussed by diverse groups in over a dozen meetings with department leaders, program managers, and providers. Findings were also shared in two day-long Learning Sessions with broad ECI stakeholder participation, where several prioritized needs were identified to support ECI’s system transformation work. The following summaries, in conjunction with the above specific findings from the Needs Assessment, were used subsequently to inform ECI’s Strategic Plan: “We are ECI.”

Iowa faces a significant shortage in the ECE workforce, and it is particularly acute in rural areas where it is difficult to recruit staff. This often translates into under enrollment in centers not able to staff classrooms, further contributing to the access gaps previously discussed.

Prioritizing workforce professional development without addressing challenges in retaining staff because of low compensation and benefits will likely not improve the number of workers or their skill level.

We need stronger communications strategies with all stakeholders regarding the importance of investment in early childhood, and what “quality” early childhood programs comprise. Such strategies could help raise awareness of the critical value of a highly trained ECE workforce capable of meeting the needs of children and families. A central partner for these communication efforts should be the business community that is well poised to support ECE workforce development and quality improvement through tax credits or on-site child care solutions.

Part 4: Data and Research: Current Indicators, Gaps, and Opportunities

Iowa early childhood partners collect a number of state and federal indicators related to child and family wellbeing to monitor and understand the state of the state and the impact of ECI services. For the 2019 Needs Assessment, we utilized many of these routine indicators in addition to expanding data collection efforts targeting new sources and types of information. This section discusses the range of indicators we already collect, strengths and weaknesses to using these data to inform statewide strategic planning, and opportunities to improve data collection and research capacity as informed by the current Needs Assessment.

Current Data and Indicators

Early Childhood Iowa (ECI) has an approved set of statewide indicators that the State Board adopted to monitor five legislated Result Areas:

Health Children

Children Ready to Succeed in School

Secure and Nurturing Families

Safe and Supportive Communities

Safe and Supportive Early Learning Environments

Every two years, the ECI Results Accountability Component Group reviews the adequacy of ECI’s approved indicators, solicits recommendations from the stakeholders across the state about potential new indicators, and reviews new measures for possible inclusion in the ongoing data collection efforts. The Component Group then presents recommendations to the ECI Stakeholders Alliance for approval. The final step in this process is for the Component Group to seek approval from the ECI State Board. As we have encouraged the use of data-based decision-making, this is a very engaging and iterative process.

In its annual report, ECI provides trend data on each of the approved indicators (see Table 2, column 1). Formal and informal discussions are hosted at various levels within the ECI structure utilizing this information and reviewing trajectory points of the data. Two other major early childhood health programs also routinely track indicators regarding child and family wellbeing: Title V and MIECHV (see Table 2, columns 2 and 3). Many of these indicators overlap in definitions and sources, while others require different approaches to capture and report information. Taken together, these three sources of data provide a broad overview of the general context of early childhood in Iowa as well as the needs and experiences of some of our most vulnerable children.

Strengths and Limitations

The intentional collection and monitoring of child and family wellbeing indicators has assisted our state in understanding the nature of child and family needs across diverse groups and contexts and over time. Strengths of this approach include (a) the breadth of indicators across multiple wellbeing domains and (b) committed state partners who support the collection and use of such information to meet needs across departments and programs (including ECI, but also for department-specific programming within health or education).

As columns 4-7 indicate in Table 2, many of our presently monitored indicators are collected from national sources. We have also historically used state department reports of aggregate population-level information that is sometimes available with more details including breakdowns at the county or school district-level. As noted throughout our IDS development efforts over the last several years, however, the limitations of aggregate reporting are that connections cannot be made across systems, which limits our capacity for evidence-informed policy making. We need more information about subpopulations of vulnerable families in particular to more accurately and efficiently target programs and resources that ensure ECI is improving outcomes for all Iowa families. Because our state is predominantly rural and our communities often have small populations (for example, 88 of the total 99 counties in Iowa are designated as rural places with fewer than 1,000 people per square mile), aggregate population-level data collected from US Census or other national tracking systems is often suppressed at the county level because of small sample sizes. Such suppression precludes our use of relevant data elements to inform local efforts on a yearly basis, though 5-year averages can provide some of the needed context. State-level reports help alleviate this limitation in some cases, but siloed services and data systems that report on one indicator at a time also present limitations for informing comprehensive, cross-systems work.

Integrated Data System (IDS) findings from the 2019 Needs Assessment revealed the value of integrated information from state systems to identify family needs and the relations between child or family characteristics and important systems-level connections and disconnections. We demonstrated the value of this information in the current work by focusing on unduplicated counts of preschool and ECE enrollment, but will continue to build this capacity to better understand the entire birth-to-five system in the future. Missing information from important systems including home visiting, early intervention (e.g., IDEA Parts B and C), and health (e.g., immunizations, lead registry, well child visits) will need to be addressed in the next iteration of the IDS. We will also benefit from continued investment in the IDS technology and governance infrastructures so we can improve the relative speed and accuracy with which we address policy-relevant needs through data and research. We are fortunate that our investments this year included securing legal agreements to include our Head Start grantees in the data system, though the data collection across 18 different grantees was not completed in time for this needs assessment. We look forward to including these data to capture both Head Start and Early Head Start enrollment patterns in our statewide analyses moving forward.

The most recent Results Accountability Component Group review of indicators also highlighted several measures that are currently not collected but that would be of high value for tracking ECI Result Areas. Many of these are highlighted in Table 2, column 7 (IDS Future), as they have been incorporated into discussions about how the IDS could be expanded to address indicator gaps such as the number of ECE slots broken down by infant/toddler and preschool ages or third grade reading proficiency. These indicators are either already collected in state systems that could be added to the IDS, or they could be created by integrating disparate data system elements. Other recommended indicators do not have a population-level data system associated with them that allow for routine monitoring, such as the percent of young children who are overweight or obese. We will continue to explore opportunities to address these gaps in future data collection efforts at the system level.

Plans for Improving Data and Research Capacity

The 2019 Needs Assessment approach and findings have supported Iowa’s momentum toward building capacities for data and research. We incorporated an IDS approach that allowed us to see, for the first time, unduplicated counts of children across our preschool programs and demonstrated the capacity of integrated data to help us understand more about the needs and service utilization patterns of Iowa families with young children. It also allowed us to test the capacity of our system to collect new data through surveys and focus groups, and capitalize on ECI’s networking and outreach to do so. We intend to include both approaches in the future as we enhance our IDS capacity and ensure we have family voices well represented in our strategic planning, implementation, and evaluation efforts.

IDS expansion efforts will include investments in technology, governance, and additional data systems to fully capture Iowa’s birth-to-five mixed delivery system. With continued national and state emphasis on privacy and improved technology standards to address it, we will continue to evolve our IDS capacity by incorporating additional state-of-the-art protocols and applications. Investments in technology and governance processes in partnership with state leaders will ensure our data are integrated with fidelity and protected for use only for those priority projects identified to support ECI’s mission.

We will also continue to incorporate new datasets and new system partners as identified through stakeholder priorities. The 2019 Needs Assessment and Strategic Planning process pointed to several systems that will be included in these expansion efforts. Such expansion will likely involve legal discussions for those not already covered in our previously secured agreements, as well as addendums to existing agreements to allow for additional data systems to be included. As indicated in Table 2, several systems have been identified for planned discussions in our next phase:

Head Start and Early Head Start (we have secured legal agreements and are currently collecting datasets for inclusion)

Home visiting and group-based parent education data (currently collected in one system to include ECI, DE, IDPH, and DHS; as well as separate systems for each of the Early Head Start grantees)

IDEA Parts B and C (provided through partnerships among DE and IDPH)

Health (e.g., immunizations, lead registry)

Child welfare

Additional data capacities will need to incorporate routine and episodic processes for including family and provider voices into indicator monitoring. The 2019 Needs Assessment contained important perspectives that could only be collected through surveys or focus groups, as the concepts of family experiences or barriers are not readily captured in administrative data systems. Unfortunately, we acknowledge that routine surveys and focus groups are costly and time consuming, so we will want to be judicious in our planning toward this end. Identifying opportunities where families or providers are already gathered that could facilitate collecting relevant feedback, or data systems where elements of data collection could be altered or adapted will be explored. It is not our intent to continue to replicate the depth of data collected for the 2019 Needs Assessment, but we also want to ensure we have capacity for family and provider feedback that is captured with high-quality and facilitates tracking and monitoring over time. Potential purposes and avenues we will explore for continued data collection include the following:

Program evaluation. We need to routinely collect specific feedback about programs that change over time, such as the recent CCA rate increase. Including surveys or focus groups to collect additional indicators to understand program implementation, experience, and outcomes will be important.

Communications feedback. With our 2019 Strategic Plan focusing on improving communications strategies, we will want to gather feedback from families, providers, and the ECI community at-large to ensure we are reaching target audiences and that messages are clear and understood.

Transition points. Our 2019 Needs Assessment attempted to capture information about family experiences in transitions between programs, but families continue to struggle when they move from one program to another. We will look for opportunities to build in more routine data collection points at key points of transition (e.g., at program exits; at kindergarten entry; etc.) to understand child and family needs as well as program strengths as families move between programs. In the Statewide Voluntary Preschool Program (SWVPP) families must be involved in at least one home visit, one family night, and a minimum of two family-teacher conferences annually [Iowa Code 281-16.3(12); 256C.3(3)g]. Intentional data collection during these family engagement points, such as at the start of state-funded preschool or kindergarten (where we know a majority of the Iowa population of children will “touch” the system) could generate indicators of system improvement that we could monitor over time and use for strategic planning.

Table 2 provides a list of current and proposed child and family wellbeing indicators. The first three columns (under the heading “Report”) identify current places where indicators are tracked and reported for program monitoring purposes. The final four columns (under the heading “Data Source”) indicate where these indicators are drawn from. The two IDS columns delineate where we have current indicators captured from administrative data, and where we have interest and discussion underway to consider inclusion in IDS future development work.

Appendix A: Analysis from Iowa's Integrated Data System

Acknowledgements: These data were collected and analyzed by faculty and students from Iowa State University’s (ISU) Department of Human Development and Family Studies (HDFS), led by Drs. Heather Rouse and Cassandra Dorius. All data were collected in adherence to legal agreements between ISU and each data-contributing department and maintain the most restrictive cross-agency privacy and security standards for data use. HDFS Post-doctoral, graduate, and undergraduate student assistants supporting the work included Quentin Riser, Maya Bartel, Seulki Ku, Jessica Bruning, Allison Gress, and Emma Kelley.

Summary

The goal of Early Childhood Iowa’s Integrated Data System (IDS) analyses were to support the development of Early Childhood Iowa’s (ECI) 2019 Statewide Needs Assessment and Strategic Plan. Analyses focused on (1) documenting unduplicated counts of children across preschool programs, (2) describing characteristics of vulnerable and underserved children, and (3) identifying differences in characteristics, services, and outcomes for children living in Iowa’s rural counties. Prior to Iowa’s investment in the IDS capacity, ECI did not have the ability to answer questions about unduplicated counts of children across our programs, or what factors outside of one system may influence participation or outcomes in another. This test of Iowa’s IDS investment provided fruitful results that have informed our new strategic plan, “We are ECI,” and prompted avenues for future research and analytics that will continue to support our birth-to-five system coordination efforts.

Data Sources

Administrative records from the Iowa’s Departments of Public Health, Human Services, and Education were the basis for all IDS analyses. Data sharing for the purpose of this Statewide Needs Assessment followed all applicable legal and ethical standards for protecting privacy and confidentiality as established by federal and state law, and were governed by signed legal agreements among all state departments and Iowa State University.

Data Integration

Administrative records from each of the data systems were integrated using deterministic and probabilistic matching techniques for one cohort of children attending kindergarten in the 2017-2018 school year. Extensive data cleaning and verification were conducted prior to the match, following standardized data verification procedures (Long, 2009) including internal consistency and missing data reviews. Birth records and education data were joined in step one, followed by joins with CCA and TS GOLD in step two. Figure A.1. presents information on Step 1 from the data integration match, including the link between birth records and kindergarten enrollment. Results indicate that 69% of the 39,200 children who were age eligible to attend kindergarten were matched with kindergarten enrollment records from the 2017-2018 school year.

Step 2 of the data integration involved matching CCA and TS GOLD data with the birth-to-kindergarten cohort. Figure A2 presents information on enrollment and assessment records from this match. Findings indicated 68% of Iowa children attended a DE funded prekindergarten program, 67% had a TS GOLD assessment (i.e., were enrolled in a center-based program of any type that used the TS GOLD assessment), and 6% participated in a CCA funded center-based experience during 2016-2017. Figure A.2. visualizes the number of children who had multiple experiences, such as children who participated in a DE funded preschool and also received a CCA subsidy for an additional child care experience the year before they entered kindergarten (n=1,310+67). It also highlights the unique experience of children who were identified in one system but not others and may have been missed by traditional approaches, for example those who had a TS GOLD assessment but did not attend a DE funded preschool program (n=1,235).

Data Analysis

Stata 15.0 (StataCorp, 2017) statistical software was used for descriptive and multivariate analyses of children in the birth-to-five cohort with a focus on better understanding the relationship between child and family demographic characteristics, the cumulative risk factors present at birth, preschool attendance, and kindergarten outcomes. Multiple logistic regression models examined whether children’s exposure to certain risks at birth significantly predicted living in a rural area, attending preschool, or reporting a range of kindergarten experiences and outcomes. For each multivariate model, relevant child and family demographic characteristics such as child race/ethnicity and gender were included. This analytic approach was ideal for answering the key questions of whether children attended preschool or had particular kindergarten experiences because logistic regression assess dichotomous outcomes (e.g., “yes” or “no” to each question) while simultaneously addressing the influence of a range of meaningful child and family experiences and characteristics.

Individual Birth Risk Variables. Birth record information was used to create risk indicators based on established definitions of risk from the research literature. A proxy for poverty was assessed as whether the child’s family received Medicaid or WIC at the time of birth. Unmarried mothers were identified as women who were not married at the time of the child’s birth. Low maternal education indicated that the child’s mother completed less than 12 years of schooling. Teen motherhood identified children born to mothers younger than age 20. Preterm or low birth weight (LBW) indicated that children were born prior to 36 weeks gestation or were born weighing less than 2,500 grams. Inadequate prenatal care indicated parents did not have a prenatal visit in the first trimester of pregnancy and had fewer than four visits overall. Prenatal Smoking was noted if mothers smoked during pregnancy or the three months prior.
Cumulative Risk Birth Variables. As children often face multiple risks that are highly correlated and accumulate over time, a cumulative risk approach was utilized to better reflect the context of children’s lives and provider deeper insights into how agencies might address the needs of vulnerable children. To this end, a cumulative risk measure was constructed as a sum of the 7 individual birth risks including poverty, unmarried motherhood, low maternal education, teen motherhood, preterm/low birth weight, inadequate prenatal care, and prenatal smoking.

Results

Figure A.3. presents information on the racial/ethnic characteristics of all children in Iowa’s IDS birth-to-five cohort as well as those who live in rural places, defined as living in an area with fewer than 1,000 people per square mile (US Census Bureau; Woods & Poole; 2017). 88 of Iowa’s 99 counties and 29% of the birth-to-five cohort are considered rural using the federal definition. Among the birth-to-five cohort, 22% of all children and 18% of rural children identify as a racial or ethnic minority in 2017-2018.

Table A.2. presents information on demographic and birth risk characteristics of children nationally, those in the IDS birth-to-five cohort, and those from the cohort who live in rural places. National estimates were assessed from publically available data sources and provided here for comparison (see table note for details). Findings indicate children who are born in Iowa and attend kindergarten are twice as likely to have a teen mother compared to national averages (4% vs. 2%). 49% of Iowa’s children qualify for Medicaid or WIC at the time of birth. Compared to all children in Iowa, rural children are more likely to qualify for Medicaid or WIC at the time of birth, be born to a teen mother, or have a mother who smoked during pregnancy.

Multiple logistic regression was used to examine whether exposure to birth risks were statistically associated with being born in a rural area (see Table A.3.). This analysis produces odds ratios, which are interpreted as the likelihood of an outcome with a given characteristic compared to the likelihood of that same outcome for a child without that characteristic. An odds ratio of 1.0, for example, indicates equal likelihood (i.e., no difference in the outcome). Odds ratios of less than 1.0 indicate a decreased likelihood of the event occurring while odds ratios greater than 1.0 indicate an increased likelihood of the event occurring. For example, children born to a teen mother are 1.5 times more likely than children without a teen mother to be born in a rural county compared to being born in an urban county. Statistically significant differences are noted with asterisks in Table A.3., and suggest that minority children (Black, Asian, or multiracial compared to white), children born preterm or with low birthweight, children born to an unmarried mother, or children whose parent is an immigrant to the United States are less likely to be born in rural areas. Children whose mothers were still teenagers, had less than 12 years of education, were in poverty, smoked during pregnancy, or had multiple children at the time of the child’s birth were more likely to live in rural areas. Children who were identified as having at least one preschool experience prior to kindergarten entry were more than twice as likely to be born in rural areas compared to children who did not have a preschool experience.

Distributions of cumulative risk among children in the birth-to-five cohort are presented overall, by rurality, and by racial and ethnic grouping in Table A.4. and Figure A.4.. Results suggest rural and minority children experience more cumulative risks compared to children born in urban areas and white children. For example, 25% of rural Iowa children experience 3 or more risks (compared to 20% of all Iowa children), as well as 42% of Black children, 34% of Hispanic children, 38% of Asian/Pacific Islander (API) children, and 37% of multi-racial children.

Table A.5. presents results of the multiple logistic regression analysis that examined cumulative risk characteristics related to living in a rural place. Findings confirm that children exposed to one, two, and three or more risks were more likely to be born in rural areas compared to children with zero risks identified at birth.

Table A.6. and Figure A.5. present results of multiple logistic regression analyses examining child demographic characteristics and individual birth risks related to several kindergarten outcomes including whether a child received free/reduced lunch (FRPL), was an English language learner (ELL), had an individualized education plan (IEP), attended school less than 90% of days in kindergarten, and was ever suspended.

Table A.6. presents odds ratios in columns organized by each kindergarten outcome. Findings indicated that minority children (Hispanic, Black, Asian, multiracial) are significantly more likely to qualify for Free/Reduced Priced Lunch and have poor attendance in kindergarten compared to white children. Children born with risks including poverty, low maternal education, unmarried mothers, teen mothers, and prenatal smoking are significantly more likely to qualify for Free/Reduced Priced Lunch in kindergarten and have poor attendance in kindergarten compared to children who do not experience these risks. Poverty is persistent over time - children who qualify for Medicaid or WIC at birth are over 10 times more likely to qualify for Free/Reduced priced lunch in kindergarten. Boys are 7.5 times more likely to be suspended in kindergarten, and 2.4 times more likely to have an IEP in kindergarten compared to girls. Poverty at birth is the only indicator that was significantly related to ALL kindergarten outcomes (FRPL, IEP, ELL, attendance, and suspensions), even when other risks and characteristics were controlled.

Figure A.5. presents the same information as Table A.6. but in a visual format. Characteristics that fall to the left of the red lines reflect significantly lower odds of experiencing the kindergarten outcome, while those to the right of the red lines indicate significantly greater odds of experiencing the outcome. Attributes with missing bars are not statistically significant.

Table A.7. presents information on demographic, birth risk characteristics, and cumulative risk characteristics as a function of ECE Experience type. The indicator of “Any PreK” was coded “yes” for children that received Child Care Assistance (CCA), were in a Department of Education prekindergarten program, or that completed a GOLD assessment (i.e., were enrolled in a center-based program of any type, including Head Start, that used the GOLD assessment). The “Any Prek” indicator represents ECI’s best estimate of “unduplicated counts” of children with such a center-based experience during the year before kindergarten. Findings indicated that 73% of the full birth cohort had at least one prekindergarten experience. Further, 51% of Iowa children that had a PreK experience qualified for Medicaid or WIC at the time of birth, and 41% of these children experience 2 or more birth risks.

Table A.8. and Figure A.6. present results from multiple logistic regression analyses examining the probability of participation in each of the early care education (ECE) experiences, relative to child characteristics and birth risks. In Table A.8. odds ratios are presented in columns organized by each prekindergarten experience. The same information is presented visually in Figure A.6. Minority children (i.e., Hispanic, Black, or multiracial) are significantly less likely to have any prekindergarten experience compared to white children. Children born with risks including low maternal education and inadequate prenatal care are significantly less likely to have any prekindergarten experience compared to children who do not experience these risks. Conversely, children with parents that qualify for Medicaid or WIC at the time of birth are more likely to have some form of prekindergarten experience the year before kindergarten.

Figure A.6. presents the same information from Table A.8. but in visual form. Characteristics that fall to the left of the red lines have lower odds of experiencing the kindergarten outcome while those that fall to the right of the lines have higher odds of experiencing the outcome. Features with missing bars are not statistically significant.